The Benefit of Advanced Age on Survival in Patients Undergoing Laparoscopic Pancreaticodoudenectomy, A Multi-Center, Comparative study-Cohort Study

Background: Management of malignant diseases in elderly patients has become a global clinical issue because of the increased life expectancy worldwide. The advancements in surgical techniques and perioperative management have reduced age-related contraindications for LPD. Past papers have reported that elderly patients undergoing laproscopic pancreatoduodenectomy (LPD) are at an increased risk compared to non-elderly patients. The aim of this paper is to compare a single centre risk of LPD in elderly and non-elderly patients.Methods: Retrospective review (n = 237) of perisurgical outcomes in patients undergoing LPD during the months of September 2012–December 2017. Outcomes in elderly patients (aged ≥75 years) were compared with those in non-elderly patients.Results: In elderly patients, transfer to ICU was more frequent (odds ratio [OR] 6.49, P = 0.001) and mean hospital stay was lengthier (21.4 days compared with 16.6 days, （P = 0.0033) than for non-elderly patients. There was no statistically significant difference in operation time (P=0.494), estimated blood loss (P=0.0519), blood transfusion (P=0.863), decreased gastric emptying (DGE) (P=0.397), abdominal pain (P=0.454), food intake (P=0.241), time to self ambulation (P=1), reoperation (P=0.543), postoperative pancreatic fistula (POPF) grade A (P=0.454), POPF grade B (P=0.736), POPF grade C (P=0.164), hemorrhage (P=0.319), bile leakage (P=0.428), infection (P=0.259), GI bleeding (P=0.286), morbidity (P=0.272) or mortality (P=0.449) between the two groups.Conclusions: Elderly patients who underwent LPD in this study had significantly good overall survival after LPD and similar to young patients . The perioperative and long term outcomes of LPD are not worse .The Both rate of ICU admission and hospital stay increased in elderly patients undergoing LPD when compared with non-elderly ones. LPD can be performed on elderly patients with similar outcomes as younger patients; therefore Age it self should not be a contraindication to LPD for pancreatic cancer, but it suggests that elderly patients with comorbidities should be more stringently selected for surgery.